Sage Journals: Discover world-class research

Abstract

Objective

To identify the prevalence of and risk factors for central sleep apnea (CSA) in infants who are diagnosed with laryngomalacia.

Study Design

Case series with chart review.

Setting

Quaternary care pediatric hospital.

Subjects and Methods

We performed a chart review in infants with laryngomalacia. All infants had diagnostic polysomnography (PSG) performed from 2003 to 2012. Infants who underwent supraglottoplasty or other upper airway surgery prior to PSG were excluded. CSA was defined as central apnea index ≥ 5. Demographic data, underlying diseases, and PSG data were reviewed and analyzed.

Results

Fifty-four patients met the inclusion criteria. The mean age at the date PSG was performed was 3.4 ± 2.7 months. The prevalence of CSA in infants with laryngomalacia was 46.3%. Odds ratio (OR) of CSA was above 2.0 in patients with the following risk factors: underlying neurologic disease, hypotonia, or syndrome (OR = 2.5, P = .13), history of apparent life-threatening events (OR = 2.7, P = .19), premature infants (OR = 2.2, P = .33), and age less than 3 months (OR = 2.3, P = .15). However, none of the risk factors were statistically significant. Analysis of sleep architecture revealed a decrease in total sleep time (345.4 ± 70.6 minutes vs 393.5 ± 68.3 minutes, P = .02) and sleep efficiency (67.7 ± 8.9% vs 75.2 ± 9.3%, P = .004) in the CSA group.

Conclusion

CSA is relatively common in infants with laryngomalacia. There seems to be a higher prevalence of CSA in infants with certain risk factors, but none of the risk factors are statistically significant. The presence of CSA can lead to alteration in sleep architecture. In addition to clinical evaluation, polysomnography may be warranted for the evaluation of infants with laryngomalacia and associated complex medical conditions.

Keywords

laryngomalacia central sleep apnea polysomnography

Get full access to this article

View all access options for this article.

References

Holinger

. Congenital laryngeal anomalies. In: Holinger

Lusk

Green

, eds. Pediatric Laryngology & Bronchoesophagology. 1st ed. Philadelphia, PA: Lippincott-Raven; 1997:137-164.

Jackson

. Diseases and Injuries of the Larynx. New York, NY: MacMillan; 1942.

Smith

Cooper

. Laryngomalacia and inspiratory obstruction in later childhood. Arch Dis Child. 1981;56:345-349.

Thompson

. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope. 2007;117(S114):1-33.

Thompson

. Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg. 2010;18:564-570.

Powitzky

Stoner

Fisher

Digoy

. Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia. Int J Pediatr Otorhinolaryngol. 2011;75:1234-1239.

Valera

FCP

Tamashiro

de Araújo

Sander

Küpper

. Evaluation of the efficacy of supraglottoplasty in obstructive sleep apnea syndrome associated with severe laryngomalacia. Arch Otolaryngol Head Neck Surg. 2006;132:489-493.

Zafereo

Taylor

Pereira

. Supraglottoplasty for laryngomalacia with obstructive sleep apnea. Laryngoscope. 2008;118:1873-1877.

Holinger

Konior

. Surgical management of severe laryngomalacia. Laryngoscope. 1989;99:136-142.

10.

Ferguson

. Congenital abnormalities of the infant larynx. Otolaryngol Clin North Am. 1970;3:185-200.

11.

Sutherland

Lack

. Congenital laryngeal obstruction. Lancet. 1897;2:653-655.

12.

Kelemen

. Congenital laryngeal stridor. AMA Arch Otolaryngol. 1953;58:245-268.

13.

Lane

Weider

Steinem

Marin-Padilla

. Laryngomalacia. A review and case report of surgical treatment with resolution of pectus excavatum. Arch Otolaryngol. 1984;110:546-551.

14.

Archer

. Acquired flaccid larynx. A case report supporting the neurologic theory of laryngomalacia. Arch Otolaryngol Head Neck Surg. 1992;118:654-657.

15.

Zalzal

Anon

Cotton

. Epiglottoplasty for the treatment of laryngomalacia. Ann Otol Rhinol Laryngol. 1987;96:72-76.

16.

McSwiney

Cavanagh

Languth

. Outcome in congenital stridor (laryngomalacia). Arch Dis Child. 1977;52:215-218.

17.

Gauda

. Upper-airway muscle control during development. In: Mathew

, ed. Lung Biology in Health and Disease. Vol. 173, 1st ed. New York, NY: Marcel Dekker; 2003:115-148.

18.

Davies

Kalia

. Carotid sinus nerve projections to the brain stem in the cat. Brain Res Bull. 1981;6:531-541.

19.

Furusawa

Yasuda

Okuda

Tanaka

Yamaoka

. Central distribution and peripheral functional properties of afferent and efferent components of the superior laryngeal nerve: morphological and electrophysiological studies in the rat. J Comp Neurol. 1996;375:147-156.

20.

Torrealba

Claps

. The carotid sinus connections: a WGA-HRP study in the cat. Brain Res. 1988;455:134-143.

21.

American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.

22.

Olney

Greinwald

Smith

Bauman

. Laryngomalacia and its treatment. Laryngoscope. 1999;109:1770-1775.

23.

Reddy

Matt

. Unilateral vs. bilateral supraglottoplasty for severe laryngomalacia in children. Arch Otolaryngol Head Neck Surg. 2001;127:694-699.

24.

Roger

Denoyelle

Triglia

Garabedian

. Severe laryngomalacia: surgical indications and results in 115 patients. Laryngoscope. 1995;105:1111-1117.

25.

Belmont

Grundfast

. Congenital laryngeal stridor (laryngomalacia): etiologic factors and associated disorders. Ann Otol Rhinol Laryngol. 93:430-437.

26.

McClurg

Evans

. Laser laryngoplasty for laryngomalacia. Laryngoscope. 1994;104:247-252.

27.

Denoyelle

Mondain

Gresillon

Roger

Chaudre

Garabedian

. Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg. 2003;129:1077-1080.

28.

Masters

Chang

Patterson

. Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children. Pediatr Pulmonol. 2002;34:189-195.

29.

Bertrand

Navarro

Caussade

Holmgren

Sánchez

. Airway anomalies in children with Down syndrome: endoscopic findings. Pediatr Pulmonol. 2003;36:137-141.

30.

Mitchell

Call

Kelly

. Diagnosis and therapy for airway obstruction in children with Down syndrome. Arch Otolaryngol Head Neck Surg. 2003;129:642-645.

31.

Mitchell

. Ear, nose and throat disorders in children with Down syndrome. Laryngoscope. 2003;113:1089-1090.

32.

Ferri

Curzi-Dascalova

Del Gracco

Elia

Musumeci

Stefanini

. Respiratory patterns during sleep in Down’s syndrome: importance of central apnoeas. J Sleep Res. 1997;6:134-141.

33.

Friedman

Vastola

McGill

Healy

. Chronic pediatric stridor: etiology and outcome. Laryngoscope. 1990;100:277-280.

34.

Dickson

Richter

Meinzen-Derr

Rutter

Thompson

. Secondary airway lesions in infants with laryngomalacia. Ann Otol Rhinol Laryngol. 2009;118:37-43.

35.

Schroeder

Jr Bhandarkar

Holinger

. Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty. Arch Otolaryngol Head Neck Surg. 2009;135:647-651.

36.

Krashin

Ben-Ari

Springer

Derowe

Avital

Sivan

. Synchronous airway lesions in laryngomalacia. Int J Pediatr Otorhinolaryngol. 2008;72:501-507.

37.

Yuen

H-W

Tan

HK-K

Balakrishnan

. Synchronous airway lesions and associated anomalies in children with laryngomalacia evaluated with rigid endoscopy. Int J Pediatr Otorhinolaryngol. 2006;70:1779-1784.

38.

O’Connor

Bumbak

Vijayasekaran

. Objective assessment of supraglottoplasty outcomes using polysomnography. Int J Pediatr Otorhinolaryngol. 2009;73:1211-1216.

39.

Sesterhenn

Zimmermann

Bernhard

. Polysomnography outcomes following transoral CO2 laser microsurgery in pediatric patients with laryngomalacia. Int J Pediatr Otorhinolaryngol. 2009;73:1339-1343.

40.

Gonçalves

MTM

Sato

Avelino

MAG

. Polisomnographic findings on children with laryngopathies. Braz J Otorhinolaryngol. 2006;72:187-192.

41.

Di Fiore

Arko

Whitehouse

. Apnea is not prolonged by acid gastroesophageal reflux in preterm infants. Pediatrics. 2005;116:1059-1063.

42.

Peter

Sprodowski

Bohnhorst

. Gastroesophageal reflux and apnea of prematurity: no temporal relationship. Pediatrics. 2002;109:8-11.

Prevalence and Risk Factors for Central Sleep Apnea in Infants with Laryngomalacia

Abstract

Objective

Study Design

Setting

Subjects and Methods

Results

Conclusion

Keywords

Get full access to this article

References